Acute pediatric cerebellitis and mutism. Case report and review of the literature (Views : 494 times)
Claudia Fantacci, Giulia Bersani, Piero Valentini, Filomena Pierri, Paolo Mariottti, Daniele Serranti, Antonio Chiaretti
Abstract
Acute cerebellitis (AC) is a rare syndrome characterized by an inflammatory involvement of the cerebellum which can complicate infections or vaccinations. AC can be a life-threatening condition, presenting with speech disorders including long-lasting mutism, usually followed by dysarthria. Clinical examination, laboratory findings and Magnetic Resonance Imaging are essential for establishing an early diagnosis and initiating prompt and adequate treatment, thereby reducing morbidity and mortality. We report a case of a child with AC complicated by mutism and we present a review of the literature of pediatric cases with this condition.
Key words: cerebellitis, mutism, dysarthria, childhood
Successful use of venovenous extracorporeal membranous oxygenation in a 22-month old boy with necrotizing pneumonia, osteomyelitis and septic shock caused by Panton Valentine leukocidin – producing Staphylococcus aureus (Views : 349 times)
Mojca Groselj-Grenc, Gorazd Kalan, Ivan Vidmar, Andreja Skofljanec, Marko Pokorn, Janez Vodiskar
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life saving treatment for patients with severe respiratory failure. We present a case of a young child with invasive Panton Valentine leukocidin-producing Staphylococcus aureus infection, which is responsible for severe and invasive infection with a high mortality rate, commonly associated with necrotizing pneumonia. Our patient presented with septic shock and necrotizing pneumonia leading to severe respiratory failure, refractory to conventional ventilation means. After 1-day of treatment, venovenous ECMO (VV ECMO) was successfully instituted and inotropic support was gradually decreased. Acute renal failure was managed with peritoneal dialysis and intermittent venovenous hemofiltration. The patient was weaned from ECMO 9-days later and was mechanically ventilated for another 3 weeks. Necrotizing pneumonia with pleuropulmonary complications was finally managed by videothoracoscopy with evacuation of debris and partial pleural decortication. Osteomyelitis was confirmed by positron emission tomography – computed tomography (PET-CT) and was surgically treated. The child was treated with antistaphylococcal antibiotic therapy for 54 days. Finally, he was discharged to a rehabilitation center without supplemental oxygen and with his neurologic status at his baseline. Our case shows that VV ECMO can be applied to children with severe bacterial pneumonia resistant to conventional ventilation strategies and with moderate circulatory failure.
Key words: extracorporeal membranous oxygenation, septic shock, Staphylococcus aureus pneumonia, Staphylococcus aureus, Panton Valentine leukocidin, child
An Unusual Cause of Recurrent Laryngeal Nerve Monitoring Failure during Parathyroidectomy (Views : 300 times)
Katarina Bojanic, Amanda R. Moraska, Juraj Sprung, Geoffrey B. Thompson, Toby N. Weingarten
Abstract
Intraoperative monitoring of the recurrent laryngeal nerve (RLN) during surgical dissection allows for real time identification and assessment of nerve function integrity. Since neuromuscular blockade interferes with electromyography, long-acting muscle relaxants cannot be used during anesthesia. We report a patient in whom monitoring of the RLN was unsuccessful because of prolonged muscle paralysis following the administration of succinylcholine, presumably due to a pseudocholinesterase deficiency.
Key words: laryngeal nerve monitoring, muscle paralysis, pseudocholinesterase deficiency
Intravenous anaesthesia for adenoidectomy in a 3-year-old child with Kartagener syndrome and sleep disordered breathing (Views : 444 times)
Sanda Stojanovic Stipic, Mladen Carev, Zeljka Roje, Mileva Frankic, Damir Fabijanic, Nenad Karanovic
Abstract
Kartagener syndrome (KGS) is a rare inherited disorder characterized by situs inversus viscerum (including dextrocardia) and primary ciliary dyskinesia resulting in chronic respiratory tract infections, bronchiectasis and sinusitis. Possible anesthesiologic challenges are related to the respiratory system and increased susceptibility to infectious complications. There are several case reports of general anesthesia in these patients, but mainly in the adult population . Here, we report on a 3-year old female child with KGS, who underwent adenoidectomy because of sleep disordered breathing (SDB).
Preoperative preparation consisted of intravenous antibiotics, steroids, as well as postural drainage and inhalations of bromhexine and salbutamol. Anesthesia was induced with propofol, fentanyl and vecuronium and maintained with a continuous infusion of propofol (150-200 µgkg-1min-1) and supplemental doses of fentanyl. The child was ventilated with oxygen/air mixture (50%:50%) in the pressure-controlled mode of ventilation to keep end-tidal CO2 between 30 and 35 mmHg. During anesthesia the child’s hemodynamic and respiratory parameters were stable. Extubation, after thorough endotracheal and oral suction, was uneventful. After two hours in the post-anaesthesia care unit (PACU), the child was transferred to the ward. To the best of our knowledge, this is the youngest reported child with KGS and SDB that underwent intravenous general anesthesia. We also stress here the importance of comprehensive pre-anesthetic preparation, i.e. postural drainage, inhalations, bronchodilators, i.v. antibiotics and steroids. Furthermore, the condition of the respiratory system in the patient with KGS is seldom appropriate at the time of surgery, so the decision to anesthetize or not, should be made on an individual basis.
Key words: Kartagener syndrome (KGS), sleep disorder breathing (SDB), total intravenous anaesthesia (TIVA)
Unintentional Cannulation of Aberrant Radial Artery: Review and Treatment Recommendations (Views : 295 times)
Francis X. Whalen, David P. Martin
Abstract
We present the case of a patient who had an unintentional placement of an arterial catheter in an aberrant radial artery. This arterial abnormality is reviewed, as are the potential consequences of intra-arterial injection. Finally, treatment recommendations are summarized.
Key words: aberrant radial artery, intra arterial injection, vasospasm
|
|
